Fatal Breakthrough COVID-19 in a Heart Transplant Recipient

A 71-year-old male presented with two days’ shortness of breath, myalgias, and chills in March 2021.  His temperature was 99.0 °F and heart rate was 108 beats/minute. The patient had received two doses of the COVID-19 vaccine four weeks apart, with the second dose 16 days prior to admission.

Laboratory exams were significant for lymphopenia and acute kidney injury (AKI). 

His brain natriuretic peptide (BNP) level was found to be elevated (an indicator of heart failure). A chest X-ray showed cardiomegaly with pulmonary vascular engorgement and an electrocardiogram showed an atrial-sensed, ventricular-paced rhythm. 5 years prior the patient received an orthotopic heart transplant. The biopsy ruled out rejection. He also had a history of obesity, hypertension, unprovoked deep vein thrombosis, and dual chamber pacemaker.

The patient was started on dexamethasone and remdesevir and his tacrolimus dose was adjusted to maintain therapeutic serum levels. The patient’s AKI improved with fluid resuscitation. 

Over the course of 18 days, the patient’s respiratory status significantly worsened despite treatment with tocilizumab. Repeat chest X-rays on day 5 showed new and worsening pulmonary edema and possible multifocal pneumonia (see Figure). IgG and IgM antibodies against SARS-CoV-2 were tested and returned negative, suggesting absence of immunity against COVID-19 infection. The patient declined intubation and expired on day 18. 

READ MORE


PS: A more recent article concluded that solid organ transplant recipients Swith suboptimal antibody responses to 4 SARS-CoV-2 doses may still benefit from a a 5th dose.

REFERENCE

Belur AD, Otero D, Dunbar Matos C. A Fatal Case of COVID-19 Pneumonia in a Fully Vaccinated Heart Transplant Recipient. The University of Louisville Journal of Respiratory Infections. 2022;6(1):13.
 

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis ...
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an incr...
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high ...
Read more